Lower respiratory tract infections in adults : a clinical diagnostic
study in general practice
Graffelman, A.W.
Citation
Graffelman, A. W. (2005, June 16). Lower respiratory tract infections in adults : a clinical
diagnostic study in general practice. Retrieved from https://hdl.handle.net/1887/3732
Version:
Corrected Publisher’s Version
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Licence agreement concerning inclusion of doctoral thesis in the
Institutional Repository of the University of Leiden
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Chapter I
Introduction and aims of this thesis
13 Introduction and aims of this thesis
1.1 Introduction
In this thesis the results of investigations on lower respiratory tract infections (LRTIs) in adults, a diagnostic study in general practice are presented. LRTI comprise differentkinds of pulmonary infections. They range from mainly sel f-limiting bronchitis to pneumonia. The latter often results in hospitaladmittance and stillcauses high rates of mortality. The recommendations for treating of the various entities within LRTI differ, i.e. for acute bronchitis only symptomatic treatment is recommended, whereas for pneumonia antibiotic treatment is obligatory.1 Especially seen in the light of the increasing resistance to antibiotics it is important to treat only those patients with antibiotics who definitely need them. To identify those patients itis relevantto develop proper diagnostic methods. M ost investigations on LRTIs have been done on patients with pneumonia admitted to hospital. Studies on patients identified and managed in general practice settings are rare. The question arises how the diagnostic work-up should be in the general practice setting. Respiratory tract diseases have been a focus of interestof the Departmentof GeneralPractice and Nursing Home M edicine in Leiden,the Netherlands. Previous studies have been published on acute bronchitis2, sinusitis3 and the diagnosis of asthma and COPD4.
1.2 Aims of this thesis
The following questions willbe addressed:
1. W hich pathogens are involved in patients with lower respiratory tract infections in a generalpractice setting? (Chapter 3)
2. W hat is the range of findings on chest radiographs in patients with lower respiratory tract infections in general practice and are these findings related to the aetiology of the infection? (Chapter 4)
3. To what extent can prediction rules from existing literature be applied to assess the presence of pneumonia in our group of Dutch general practice patients with lower respiratory tractinfections? (Chapter 5) 4. Is it possible to predict the presence of a bacterial infection in patients
with lower respiratory tractinfections in generalpractice? (Chapter 6) 5. Can the presence of Mycoplasma pneumoniae be predicted by
information obtained from medicalhistory taking,physicalexamination and simple laboratory tests? (Chapter 7)
Chapter I
14
the prediction of bacterial infections and the use, resistance and efficacy of antibiotic treatment in patients suspected to have a lower respiratory tract infection.
1.3 References
1. Verheij ThJM, Salomé PhL, Bindels PJ, Chavannes AW, Ponsioen BP, Sachs APE, Thiadens HA, Romeijnders ACM, Van Balen JAM. NHG-Standaard acuut hoesten. Huisarts Wet 2003;46:496-506.
2. Verheij ThJM. Acute bronchitis in general practice (Thesis). Leiden: University of Leiden, 1995.
3. De Bock GH, Dekker FW, Stolk J, Springer MP, Kievit J, Van Houwelingen JC. Antimicrobial treatment in acute maxillary sinusitis: a meta-analysis. J Clin Epidemiol 1997;50:881-890.
